Diagnostic and marking systems, devices and methods are known and used by medical professionals in dedicated units of numerous hospitals and free-standing cancer treatment centers, and some incorporate balloons to achieve and maintain proper placement during diagnosis.
Diagnostic and marking tasks often utilize devices of the type intended to be inserted into living body cavities through existing body orifices or into surgically executed openings for treatment under the skin of a patient. For example, once a catheter and its balloon are inserted in a prescribed manner into a body cavity, its balloon can be inflated to mark the boundary of the body cavity during radiographic examination, and the inflated balloon may also be used to move, push or otherwise manipulate body tissue during the diagnostic procedure.
Various devices, systems and methods have been developed, each typically being designed for a specific diseased body organ, area or part and/or for one or more treatment locations. Whether a treatment regimen involves a one-step or a multi-step protocol, it is important to maintain a good balance among radiation dosage, placement and timing. To do so requires precision in diagnosis so that the target location or locations are treated with the radiation source while protecting as much as possible areas of the body that are disease-free and otherwise could be vulnerable to unintended treatment if positioning with respect to the treatment locations is not modified during diagnosis, marking and treatment.
Proper, precise and accurate marking, diagnosis and manipulation procedures can precede and be reproduced or maintained during carcinoma treatment procedures, such as when following high dose rate (HDR) brachytherapy. At times, the diagnoses by the radiation oncologist will be intended for regimens using low dose rate (LDR) brachytherapy, typically based on cesium delivery as in 137Cs. For HDR brachytherapy regimens, 192Ir is frequently used because of its high specific activity. Diagnoses for using other isotopes are available and used as warranted. The degree of treatment measurement is in terms of units of radiation exposure (in roentgens or Gray or Gy), and often these are prescribed at specific locations and points. Details in this regard are known to radiation oncologists, medical physicists and other medical professionals experienced in brachytherapy and cancer treatment in general. An objective also is to provide reasonably constant and predictable dose rates at each specific location that diagnosis and marking have determined are most beneficial for the patient.
Intracavitary and percutaneous radiation treatment diagnoses need to be exacting and specific at each radiation target location. Typically important is protection of tissue that is not diseased. Pre-treatment diagnoses also are important for developing a plan for dose rate and duration specifics, for example.
In terms of protecting non-diseased tissue, an example is presented relating to intrauterine diagnosis and treatment where it typically is important to minimize, if not eliminate, radiation exposure to the bladder and the rectum. Generally, marking and diagnosis devices, as well as brachytherapy devices, are visible (or can be rendered visible) under x-ray images or other imaging technologies in order to insure intended placement and to allow the medical physicist or radiation oncology professional to generate a radiation treatment plan specific for this placement and for the particular anatomy and disease location and severity for the particular patient and for each particular treatment event.
It will be appreciated that radiation delivery systems can be used in treatments that are applied manually or remotely using remote afterloading systems. In remote afterloading systems, the radioactive materials are delivered from a safely contained access location to distal reaches of the delivery tubes at treatment portions or locations. Radioactive material can be in the form of wires, seeds, liquids or other species. In such systems, the radioactive material typically is delivered via remote control, such as by operation of a motor, after the medical professionals are out of view from the treatment room. Such remote delivery equipment can move the radioactive dose into the applicator already positioned within the body cavity, the accuracy of which is facilitated by the marking and diagnosis device or catheter.